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Neuroanesthesia
Anesthesia and Pain Medicine 2009;4(3):191-196.
Published online July 31, 2009.
Medical managements of intracranial hypertension
Sung Sik Park
Department of Anesthesiology, School of Medicine, Kyungpook National University, Daegu, Korea. sspark@knu.ac.kr
Abstract
Normal intracranial pressure (ICP) is below 10?15 mmHg.It may increase as a result of traumatic brain injury, stroke, neoplasm or other pathologies. When ICP is pathologically elevated it needs to be lowered. Effective management of intracranial hypertension involves meticulous avoidance of factors that precipitate or aggravate intracranial hypertension.It is important to rule out space occupying lesion that should be surgically removed.Medical managements of intracranial hypertension include maintenance of proper oxygenation and cerebral perfusion pressure and osmotheraphy with either mannitol or hypertonic saline. For intracranial hypertension refractory to initial medical treatment, profound hyperventilation, barbiturate coma or hypothermia should be considered. Steroids are not indicated and maybe harmful in the treatment of intracranial hypertension caused by traumatic brain injury.
Key Words: barbiturate coma, hyperventilation, hypothermia, intracranial hypertension, osmotheraphy
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